Is
every woman a candidate for a waterbirth?
So
long as there are no medical contra-indications, any woman is
a possible candidate for a waterbirth. Once health concerns
are set aside, it is important to think (and be realistic) about
your philosophies, thoughts, and fears relating to birth. This
realistic appraisal will be helpful in assessing whether you
might be a realistic candidate for a waterbirth. It is best
to set-up an appointment with a waterbirth consultant/doula.
What's
the difference between water immersion and waterbirth?
Water
immersion means that the woman labors in water, but gets out
of the tub to deliver the baby. Waterbirth means that the woman
labors in the water and gives birth to the baby into water.
Where
can you do a water immersion or waterbirth?
You
can do a water immersion or waterbirth at home, in a hospital,
at a birth center, or in the ocean.
What
are the most common reason women want
to labor and/or give birth in water?
The
most common reason women like the water is because it feels
good. Water helps women cope with the sensations and surges
of labor and birth. Many women report that the water enables
them to override the epidural. In fact, when speaking with a
woman whose labor I attended, I noted, "From my observations
of you during labor, if you had not had the tub available, I
believe there was an 80 percent chance you would have gotten
an epidural." "Eighty!" She exclaimed back, "200 percent I would
have gotten the epidural. The water saved me."
What
is the appropriate temperature for the water?
The
water should not exceed the body temperature, which is approximately
97 degrees Fahrenheit (37 degrees Celsius). Temperatures exceeding
this level can lead to hyperthermia and dehydration in the mother
and the baby.
When
should I get into the tub?
Before
getting into the tub, it is recommended that you wait until
your contractions are strong and consistent, which occurs around
5 centimeters. Some women have utilized the water for rest and
regeneration in early labor (before 5 centimeters,) if there
has been a long prodromal stage. (Irregular contractions, with
a small amount of dilation or none at all.) BB © 2010
How
deep should the water be?
Ideally,
deep immersion is a key factor. If the bath or pool is not deep
enough, up to breast level and completely covering the belly,
then the benefits may be less noticeable. Full immersion promotes
more physiological responses, the most notable being a redistribution
of blood volume, which stimulates the release of oxytocin and
vasopressin.
How
long should I stay in the water?
Most
studies have indicated staying in the water for an hour or two.
Twenty minutes in the bath is not enough for the physiologic
responses to work effectively. Primips (first time) and multips
(multiple births) can get into the water at 7 cm or 8 cm dilation
and begin to experience pushing urges within the first hour
of immersion. If the contractions begin to space out and slow
down, it is advisable to get out of the tub and become ambulatory.
Will
I be able to switch positions while in the tub?
You
are encouraged to try different positions and to do what works
best for you at the time. You are much more able to switch positions
with less effort while in the water than on land.
Can
my husband/partner get in the tub with me?
Another
person can get into the tub with you. If the father or anyone
else gets in the tub, make sure they have showered and are not
harboring any staff infections on their bodies. Make sure the
tub is filled with less water, since the water level increases
1" to 2" for every person in the tub. Some women prefer that
their partners support them from outside the tub, while others
like their partner to join them in the water.
Can
I drink while I am in the tub?
It
is imperative the woman and her attendants drink fluids with
glucose while in the birth room. Dehydration of the mother leads
to low blood volume and could possibly result in orthostatic
hypotension, passing out when standing up to get out of the
pool.
Is
there a risk of infection for the baby?
So
long as you clean the tub beforehand, use clean water, a new
hot water hose and a disposable tub liner (if your tub calls
for one,) risk of infection is small. Because the mother and
the baby share the same antibodies, there is no risk of the
baby "catching" anything from the mother. Note, however, that
if the water has been in the tub for more than 24 hours change
the water as a sanitary precaution.
Is
there a risk of infection for the mother?
There
is little known risk of infection to the mother. Water also
dissipates bacteria so pathogens would more than likely be weaker
in the water. Since the baby is moving downward and out of the
birth canal, it does not follow logically that bacteria can
travel upward and into the birth canal. A mother is more apt
to get an infection from too many vaginal exams; probes, Aminihooks
or scalp hooks before laboring in water after her membranes
have ruptured.
What
if debris gets in the water during labor? 
If
birth or fecal matter enter the water, use a scooper (available
at most pet supply stores or in your tub kit) for removal.
Is
it safe to urinate and/or have a bowel movement in the tub?
Urine
is a sterile substance, so it is permissible for the laboring
woman to urinate in the water. Birth attendants and partners,
however, should get out of the tub and use the bathroom. It
is also permissible to release a bowel movement in the water
(and this may very well happen during the third stage of labor).
Remove the fecal matter from the water with a scooper as soon
as possible.
What
are the contraindications (risks) for a water immersion or birth
for mother and baby?
*See
BENEFITS/RISKS section in website.
How
does the baby breathe if it is born into water?
There
are 5 inhibitory factors, which prevent a baby from inhaling
water when born:
- The
baby in utero is oxygenated through the umbilical cord via
the placenta. When a baby breathes air, the intercostal muscles
and diaphragm move in a regular and rhythmic pattern. 24 to
48 hours before the onset of labor the prostaglandin E2 levels
form the placenta cause a slowing down or stopping in the
fetal breathing movements (FBM). The diaphragm and intercostal
muscles become suspended and there is a decrease in the FBM.
At the birth, the baby's muscles for breathing simply don't
work.
- Babies
are born experiencing acute hypoxia or lack of oxygen. This
is built in response to the birth process. Hypoxia causes
apnea and swallowing, not breathing or gasping.
- The
temperature differential is another factor. When a baby is
born into water so close to maternal temperature the baby
doesn't detect a change so no breathing is initiated. In some
places where an oceanbirth occurs, the water is much cooler
than maternal temperature. This is an area for reconsideration
since lower temperatures do not seem to stimulate the baby
to breathe while immersed either.
-
Water is a hypotonic solution and lung fluids present in the
fetus are hypertonic. Hypertonic solutions are denser and
prevent hypotonic solutions from merging or coming into their
presence. Thus, as water passes through the larynx it does
not pass into the lungs.
-
The 'mammalian dive or autonomic reflex' built into all newborns
is present at birth and mysteriously disappears around 6 to
8 months. This reflex is associated with the taste buds along
the larynx. When a solution hits the back of the throat and
crosses the larynx, the taste buds interpret what substance
it is and the glottis automatically closes: the solution is
then swallowed, not inhaled.
(*These five inhibitory factors are from Waterbirth Basics,
From Newborn Breathing to Hospital Protocols by Barbara Harper,
Midwifery Today with International Midwife, Summer 2000, Number
54. www.midwiferytoday.com)
It
has been discovered newborns exposed to water training up
to 8 months after birth are able to avoid atrophy of the
mammalian dive reflex.
(Waterbirth
and the Emergence of the Newborn, by Marina Alzugaray, CNM,
Midwifery Today with International Midwife, Summer 2000,
Number 54. www.midwiferytoday.com) BB © 2010
When
should the baby be lifted from the water?
The
baby should be gently lifted from the water as soon as the entire
body is born. The reasoning behind this is, if the placenta
separates quickly and the baby remains under water, oxygen to
the baby may be compromised. If she desires, the new mother
can reach down and lift the baby up to her chest. Alternatively,
the father/partner or midwife may lift the baby up as well.
It is important to lift the baby slowly so as not to accidentally
tear a short cord.
Can
I birth the placenta into water?
This
is a matter to discuss with your individual medical caregiver.
Some women choose to birth their placentas into water in order
to extend the bonding with their babies. Make sure there is
an adequate sized 'waiting bowl' to hold the placenta as it
floats in the water, attached to the cut or uncut umbilical
cord. However, if the mother remains in the water and the placenta
takes too much time to present (this is relative to your caregiver
perception of time,) it is best to get out of the tub.
Is
it important that the doula I hire is not highly experienced in
waterbirth or water labor?
There
is so much information made readily available to the public
on water labor and water birth that it is relatively easy and
worthwhile for doulas to read up and educate herself. The Internet,
books, articles, magazines, and videos offer a plethora of information.
Going to a "Waterbirth Consultant" for a consultation is also
advisable. It is most important you have a strong connection
with the doula who will attend your birth. Educating and participating
is a moment-to-moment experience.
Why
aren't there more hospitals in the Untied States offering waterbirth?
From 1995 to2000 there were great advances in the United States.
The U.S. movement is at least five years behind the European
movement in acceptance in hospital environments. Midwives and
homebirth in the U.S. have been offering waterbirth longer than
most of the European counterparts. The United Kingdom has government-sponsored
research and data reporting as well as the Cumberledge Report.
The states that have made the most progress in the U.S. are:
Illinois, Ohio, New York, New Hampshire, North Carolina, Massachusetts,
and Maine. The East Coast is changing faster than the West Coast.
California has only a handful of hospitals that provide waterbirth
services and none in southern California.
That's
why you will want to give birth at AquaNatal Birth Center in Chino,
CA! .
